Organization
INSTITUTE OF FACIAL SURGERY ST PAUL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY KENT BRUNSOMAN D.D.S., M.S. (PRESIDENT)
(651) 774-9611
Entity
Organization
Contact information
Practice address
1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
(651) 774-9611
(651) 748-3704
Mailing address
1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
(651) 774-9611
(651) 748-3704
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
01/09/2007
Last updated
08/22/2020
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